MEDICARE: SERVICES CENTER FOR INDEPENDENT LIFE, INC.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	251B00000X	Case Management Agency	0976747	CA

General Provider Information

NPI Number	:	1093024309
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SERVICES CENTER FOR INDEPENDENT LIFE, INC.

Provider Business Mailing Address
First Line	:	107 SPRING ST
Second Line	:
City	:	CLAREMONT
State	:	CA
Zip	:	91711-4930
Country	:	US
Telephone Number	:	909-621-6722
Fax Number	:	909-445-0727

Provider Business Practice Location Address
First Line	:	107 SPRING ST
Second Line	:
City	:	CLAREMONT
State	:	CA
Zip	:	91711-4930
Country	:	US
Telephone Number	:	909-621-6722
Fax Number	:	909-445-0727

Authorized Official
Title or Position	:	EXECUTIVE DIRECTOR
Name	:	MR. LAWRENCE GRABLE
Credential	:
Telephone Number	:	909-621-6722

Provider Enumeration Date	:	10/04/2010
Last Update Date	:	05/29/2014

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